Tuesday, 9 June 2020

Patterns to Avoid

I'm not sure how I could have done this without their dedicated document delivery staff, including Stephen Chiaffone, Walter Lipton, Marina Bonilla, Dennis Campbell, Katherine Molina, and Christopher Borecky, who sent me articles (current and historical) within hours of my request. Chris Warren, PhD, also of the Academy, gave me wonderfully encouraging words of wisdom early in the process. They move your body fluidly through a range of motion, and are held at the end points for a few seconds while the muscle stretches. They're important to use before your HIIT workout to warm up the muscles, loosen tendons and ligaments, and lubricate the joints. Though studies demonstrate that they can improve athletic performance, their primary role, as far as I'm concerned, is to prevent injuries. To begin any dynamic warm-up, start in a balanced, neutral position, and deliberately and slowly follow the instructions for moving the target body part. Holding onto a counter or chair-back can make these maneuvers a little easier, help with balance, and prevent falls. Though very beneficial, dynamic stretches can irritate a tight and misaligned body if done too aggressively. Therefore, begin by doing just one or two reps of each exercise, and start with shorter ranges of movement. Increase the number of exercises and amount of movement after a week or two--each exercise should take only about 20 seconds total. While static stretches should be done daily, dynamic warm-ups should be done only two or three times a week, just before your HIIT workouts. A couple of the dynamic warm-up exercises are the same or similar to HIIT exercises described later. As we learn more about gravity, for example, we will never have cause to wonder if it really exists. That's established - that's the cake; The truth about food, diet, and health can be treated much the same. There is a wonderful model in biology for filtering the known from alternatives, including those as yet undiscovered, while leaving room for acceptance of the new: it's how our immune system works . The immune system is an elegant system of defense of us against every manner of potentially hostile them. It's not a perfect defense. Sometimes, it mistakes innocuous them for menacing marauders, as in the case of allergic reactions to pollen. Sometimes, it mistakes bits of us for perilous them, as in the case of autoimmune disease.

But still, it is very, very good, and thus a robust analogy for the kind of defense we should all be seeking against health-related lies. How does the immune system work, and how might we emulate it in our pursuit of truth about food? Novak, head of Archives and Special Collections at the Augustus C. Long Health Sciences Library at Columbia University Medical Center, was not only a great help but a great conversationalist, so I'll try to find another project that brings me to his basement haunts. Bob Vietrogoski, who had been Steve's assistant but has since moved on, tipped me off to the Viola Bernard manuscripts, which blossomed into a article. I am also indebted to the staff of the Archives and Manuscripts of the Wellcome Library for the History and Understanding of Medicine in London, including Rachel Cross, who facilitated the process of retrieving images; Jack Eckert, the reference librarian at the Center for the History of Medicine at the Francis A. Countway Library of Medicine, an alliance of the Boston Medical Library and the Harvard Medical School; Toby Appel, at the Harvey Cushing/John Hay Whitney Medical Library, Yale University; Sarah Hutcheon, a reference librarian at the Schlesinger Library of the Radcliffe Institute for Advanced Study, Harvard University; Ron Sims, Special Collections librarian, Galter Health Sciences Library, Northwestern University; Jim Gehrlich and Elizabeth Shepard, at the Medical Archives of New York-Presbyterian/Weill Cornell Medical Center. Done slowly and deliberately, they can be an effective way to warm up the body. Done more rapidly--as during the HIIT workout--they serve to strengthen the body and get the heart rate pounding. Stand with your feet shoulder-width apart. Raise your left arm straight over your head and place your right hand on your hip. Bend your trunk laterally to the right as far as it will comfortably go. Return to the center, switch arm positions, and then bend laterally to the left. Return to starting position. Stand with your feet shoulder-width apart, arms out to the sides and parallel to the ground, elbows fully bent, and fists touching your chest.

Rotate your upper body and head to the right as far as you can comfortably go so that you're looking over your right shoulder. In a smooth motion, move back to the center and continue rotating to the left. For the better part of a decade, I taught a course at the Yale School of Public health entitled Clinical Concepts in Public Health . Leaving aside the details, this was an attempt to convey to public health students in one semester all of the most important and interesting things I learned in four years of medical school and the three years of training in Internal Medicine that followed: how the human body is supposed to work, and how each organ system is prone to fall apart when stricken. To compress med school's greatest hits into a single semester of weekly classes, I learned to rely on analogy. A good analogy is remarkably good, and efficient, at producing the ah, I see it now! For the immune system, my analogy was sleep-away camp, and keeping track of your underwear. It worked for most of my students, so I imagine it's likely to work as well here. Whether or not you've ever been to sleep-away camp, you can imagine the challenges of reliably retrieving your underwear from a communal laundry. The likelihood that no other camper's underwear will look like yours is remote. The likelihood that every other camper's underwear will be distinctive and readily recognizable as other is less likely still. And finally, there is always some new idea about the best way to make underwear, and some avant-garde camper from the most fashionable of families is apt to turn up with that. I was fortunate to reconnect with Karen Smith Duffy, a high school classmate (Livingston High School 1980) during my hunt to get a copy of a 1956 article from the Daytona Beach News Journal. Karen is the news research editor there. For their medical expertise, I am appreciative to but do not hold accountable: Jason Barritt, PhD, who explained to me the biology of the human ova with an enthusiasm I never knew a man could have for women's eggs; Copel, MD, who answered thousands of e-mails immediately; Florence Haseltine, MD, PhD; Herbst, MD; Frederick Naftolin, MD, PhD; Sherwin Nuland, MD;

Pasquale Patrizio, MD, along with Dr Patrizio's helpful senior administrative assistant Jeannine Estrada and his gracious embryologist Kathleen Greco; Marcie Richardson, MD, Jeff Riffell, PhD; Return to starting position. Stand with your feet shoulder-width apart and arms extended straight out to the sides, level with your shoulders. Simultaneously move your straight arms toward the center, crossing them in the middle of your chest, and continuing toward the other side. Move your arms back to the starting position and repeat, crossing the other arm on top. Sit or stand with good posture. Bring both arms straight up and, in a continuous motion, bring them backward, down, then forward, forming a circle. Repeat in the other direction. Start on all fours with your hands beneath your shoulders. Bring your right hand up and lightly place it on the back of your head with your elbow pointing to the side. Now bring your right elbow down so that it points toward the floor, rotating your head and shoulder with it. You can't count on finding your own underwear by knowing every other possible kind of underwear you will need to overlook. There's really just one thing to do: put your initials in your underwear, and don't accept any that aren't so labeled. The immune system works just this way. The initials are not letters written with indelible sharpies, but proteins bonded to the surface of our cells. These particular proteins expressly identify self as self, and thus are called histocompatibility antigens. The term histo refers to tissues of the body, and compatibility is self-explanatory. Antigens are proteins with the potential to evoke an antibody response. When things are working as they should, our own bodies do not produce antibodies to our own histocompability antigens.

While these proteins would cause anyone else's immune system to mount an attack, they tell our own: it's OK. It's just me . While my children were embarrassed to know that their math teacher came to our home, I am indebted to Jonathan Cuba for sneaking out of school to figure what I was doing wrong with all the digital photographs--why I was receiving high-resolution ones from Arlene and everyone else and sending them out as thumbnails. He's truly a great teacher, had tons of patience with me, and gave me his jump drive when nothing else seemed to store the images accurately. When I began the article, I knew I needed to learn more about historical research, so I became a part-time student in the Division of Sociomedical Sciences at the Joseph L. Mailman School of Public Health at Columbia University. The SMS team, a brilliant, caring group of professors who study history to guide and shape public policy, includes Amy Fairchild, PhD; David Rosner, PhD; Ronald Bayer, PhD; James Colgrove, PhD; Barron Lerner, MD, PhD; Nancy Stepan, PhD; After a brief pause, move your elbow back up as far as you can comfortably go, rotating your head and shoulder with it, until your elbow is parallel to or above the floor, if possible. Switch sides and repeat. Lie on your right side with your knees pulled up and arms straight out in front of you. Keeping your body in place, lift your left arm up and across your body toward the left side. Try to touch the ground on the left side. Return to starting position. Switch sides. Repeat several times.

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